Myelin oligodendrocyte glycoprotein antibody disorder (MOGAD) optic perineuritis following severe COVID19 infection

Purpose: To describe the case of bilateral myelin oligodendrocyte glycoprotein antibody disorder (MOGAD) perineuritis following severe COVID19 pneumonia. Observations: A 56-year-old man presents with bilateral vision loss (BCVA OU of counting fingers) following severe COVID19 infection. Neuroimaging revealed bilateral perineuritis, with MOG-IgG antibody positive (1:20), confirmed by cell-based assay, elevated ESR and CRP (42 mm/h and 8.2 mg/dL, respectively). The patient was started on IV methylprednisolone with significant improvement in visual field testing bilaterally, followed by slow steroid taper. After 6 months, repeat MOG-IgG antibody was negative (seronegative conversion) and inflammatory parameters (ESR and CRP) were within normal limits. Conclusions and importance: COVID-19 has been previously associated with MOGAD optic perineuritis, mostly with higher antibody titers. This case suggests a new pathophysiological hypothesis in which concomitant cytokine storm in severe COVID-19 disrupts the blood-brain-barrier, leading to the entry of even lower MOG-IgG titers to the central nervous system (CNS) and exacerbate severe visual loss. Clinicians should be aware of the association of COVID-19 and MOGAD.